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Flashcards in Traveler's Medicine Deck (17)
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Resource

CDC's website or the yellow book

1

Meningococcal disease prevention

Required by Saudi Arabia during the time of the Hajj

Recommended for hyperendemic regions including the meningitis belt of Africa during the dry season December through June

Symptoms of meningitis are fever, severe, unrelenting headache, nausea, stiff neck and mental status changes which require urgent treatment to avoid the risk of permanent brain damage and death

Three vaccines are available Menactra (2 doses for age 9-23 months or 1 dose for age 2-55), Menveo (2-55), Menomune (>56 yo)

Vaccine should be given 7 to 10 days prior to exposure

2

Prevention of diseases transmitted by insect bites

Primarily mosquitoes which can transmit Japanese encephalitis, yellow fever, dengue and malaria

Tsetse fly spread African sleeping sickness

There is no vaccine or prophylactic drugs for African sleeping sickness, malaria, dengue

3

Prevention of mosquito borne illness

1. Stay and sleep in screened or air-conditioned rooms
2. Cover exposed skin with long sleeve shirts, long pants and hats
3. Use a bed net, which can be pretreated with mosquito repellent
4. Use mosquito repellent containing 20 to 30% DEET; permethrin can be used to treat closing gear and bed nets but should not be applied to the skin

4

Prevention of African sleeping sickness

As the fly can bite through thin fabric closing should be medium weight and neutral in color as the flies attracted to bright or dark colors

No evidence if insect repellent works

5

Prevention of Japanese encephalitis

These prevention against mosquito bites and consider vaccine (Ixiaro)

6

Prevention of yellow fever

Caused by a virus transmitted by mosquitoes

Common in the tropical and subtropical areas of south America and Africa

Often asymptomatic but can present like influenza. Most patients improve but can progress to jaundice, hemorrhagic symptoms and risk of shock organ failure

Treatment is usually with fluids, analgesics and antipyretics remember to never use aspirin or inside as you will increase the risk for bleeding

Vaccine is highly recommended inpatient received a yellow card signifying their vaccination

This is a live vaccine

Should not be used in: immunosuppressed, pregnant or anyone with a hypersensitivity to eggs, egg products, chicken proteins or gelatin, myasthenia gravis

7

Malaria

transmitted by mosquito in tropical and subtropical areas of Asia, N. & S.America, Middle East, N. Africa and S. Pacific (high risk sub-Saharan Africa).

Most common strain: P. Vivax (building resistance)

8

Antimalarial: Mefloquine (Larium)

Dose: once weekly 1–2 weeks prior to travel

Side effects: psychiatric (anxiety, paranoia, depression, hallucinations and psychosis) and neurologic (seizures, dizziness or vertigo, tinnitus, and loss of balance)

9

Antimalarial: Atovaquone/Proguanil (Maleron)

once daily 1–2 days before travel and is taken for seven days post travel

Well-tolerated but cannot be used during pregnancy

10

Antimalarial: chloroquine

Dosed once weekly and the started 1-2 weeks before travel and is taken four weeks post travel

Side effects: visual problems such as retinopathy, can exacerbate psoriasis, G.I. upset

should not be used in pregnancy or severe renal impairment

11

Antimalarial: primaquine

Effective for P. vivax

Dosed once daily and is started 1–2 days before travel and taken for 7 days post travel

Cannot be taken in pregnancy or G6PD deficiency

The CDC requires G6PD screening prior to initiation

12

Typhoid fever

Highest risk in southern Asia

Spread through contaminated (feces) food or water

Can also be spread through sexual contact among men who have sex with men

Symptoms: fatigue, fever, malaise, rose-colored spots on trunk. Will progress to intestinal hemorrhage or perforation which is fatal

Vaccine (Vivotif Berna capsules or Typhim Vi IM injection) is recommended but only 50 to 80% effective ; should use precautions with food and water and wash hands frequently

13

Vivotif Berna capsules or Typhim Vi IM injection

Capsules: four capsules every other day, refrigerated, with cool liquid one hour before a meal, this is completed one week far to travel

Injection: IM greater than or equal to two weeks before exposure

14

Travelers diarrhea prevention

Often caused by unclean food or water (E. coli)

Precautions: eat food that is cooked and served hot, avoid food on a buffet, eat raw fruits and vegetables only if washed with clean water or peeled, drink only beverages from factory sealed containers and avoid ice, wash hands frequently

Treatment: hydration and loperamide or Imodium can be used, bismuth subsalicylate it can also be used that should never be used in children due to the rest of Greysens room

15

DVT prevention

Wear compression stockings, get up occasionally and walk around, perform exercises while sitting

16

Motion sickness, altitude sickness, jet lag

Acute mountain sickness symptoms: dizziness, headache, tachycardia and shortness of breath

Primary prophylactic medication is Acetazolamide (diamox) 125 mg twice daily

Acetazolamide is contraindicated with a sulfa allergy